Blood Processing

Policy No: 110
Originally Created: 09/01/2015
Section: Medicine
Last Reviewed: 09/09/2024
Last Revised: 11/01/2022
Approved: 10/10/2024
Effective: 12/01/2024
Policy Applies To: Group and Individual & Medicare Advantage

The policy applies to inpatient and outpatient facilities.

Blood Components

Whole Blood

• Whole blood contains red cells, white cells, and platelets (~45% of volume) suspended in plasma (~55% of volume).

Red Cells

• Red cells, or erythrocytes, carry oxygen from the lungs to the body's tissue and take carbon dioxide back to the lungs to be exhaled.

Platelets

• Platelets, or thrombocytes, are small, colorless cell fragments in the blood whose main function is to interact with clotting proteins to stop or prevent bleeding.

Plasma

• Plasma is a fluid, composed of about 92% water, 7% vital proteins such as albumin, gamma globulin, anti- hemophilic factor, and other clotting factors, and 1% mineral salts, sugars, fats, hormones, and vitamins.

Cryoprecipitated Antihemophilic Factor (AHF)

• Cryoprecipitated AHF (Cryo) is a portion of plasma rich in clotting factors, including Factor VIII and fibrinogen. It is prepared by freezing and then slowly thawing the frozen plasma.

Payment for blood, blood products, and blood processing related services will be in accordance with the guidelines outlined in this reimbursement policy.

Billing Guidelines
Revenue Codes for Blood or Blood Products:

• 0381 – Packed red blood cells
• 0382 – Whole blood
• 0383 – Plasma
• 0384 – Platelets
• 0385 – Leukocytes
• 0386 – Other Blood Components
• 0387 – Other Derivative (Cryoprecipitates)

• 0389 – Other Blood and Blood Components

Revenue Codes for Blood Administration:

• 0391 – Blood Administration

Revenue Codes for Blood Processing/Storage:

• 0390 – Blood Processing/Storage
• 0392 – Blood Processing/Storage; Processing and Storage; or

• 0399 – Blood Processing /Storage; Other Processing and Storage

The following is considered included in the revenue code reimbursement for processing and storage costs and should not be billed separately:

• Blood product collection
• Safety testing (Including but not limited to Hep C, Hep B, HIV, Viral and Bacterial testing, Blood Typing, Crossmatching, adverse reaction testing)
• Retyping
• Pooling
• Irradiating
• Leukocyte-reducing
• Freezing
• Thawing blood products
• Cost of blood delivery (e.g., transportation costs)
• Cost of blood monitoring
• Cost of blood storage

• Splitting

Inpatient Facility
Inpatient facilities bill for blood, blood product and blood product related services using Revenue Codes on the Uniform Billing (UB-04) form/format. Inpatient facilities do not use Current Procedural Technology (CPT®/HCPCS Level I) or Healthcare Common Procedure Coding System (HCPCS/HCPCS Level II) codes on the UB-04 form/format.

Outpatient Facility
Outpatient facilities bill for blood, blood product and blood product related services using Revenue Codes in addition to using the appropriate CPT/HCPCS Level I or HCPCS/HCPCS Level II codes for the product or services on the Uniform Billing (UB-04/CMS-1450) form/format.

1. Inpatient and Outpatient Facility Blood Processing Processing/Storage with no cost for Blood or Blood Product: When a facility furnishes blood or a blood product collected by its own blood bank for which only processing and storage costs are assessed, or when a facility procures blood or a blood product from a community blood bank (i.e. Puget Sound Blood Center) for which it is charged only the processing and storage costs incurred by the community blood bank.
   • Bill one of the Revenue Codes for Blood Processing/Storage (0390, 0392, 0399) for each date of service.
   • Only one processing/storage fee per date of service may be billed regardless of how many processes were used to prepare the blood product.
   • Include the number of units transfused on the claim line for each date of service (units not transfused are not reimbursable).
   • Outpatient Facilities must also bill using the appropriate CPT/HCPCS Level I or HCPCS/HCPCS Level II codes for the service/product for each date of service.
   • Charges for the Blood Administration can be billed on a separate line with Revenue Code 0391 for each date of service. Blood Administration is considered included in reimbursement for Room and Board per Reimbursement Policy Fac 103.
2. Processing/Storage with cost for Blood or Blood Product: When a facility pays for the actual blood or blood product itself, in addition to paying for processing and storage costs when blood or blood products are supplied by either a community blood bank or the facility’s own blood bank.
   • Bill one of the Revenue codes for Blood Processing/Storage (0390, 0392, 0399) for each date of service.
   • Only one processing/storage fee per date of service may be billed regardless of how many processes were used to prepare the blood product.
   • On a separate claim line Bill charges for blood or blood product using Revenue Codes 0381-0389.
   • Bill the same number of units transfused for that date of service on both the line for the Blood/Blood product and the Processing/Storage (units not transfused are not reimbursable).
   • The same date of service should be billed on both the line for Blood/Blood product and the Processing/Storage.
   • Outpatient Facilities must also bill using the appropriate CPT/HCPCS Level I or HCPCS/HCPCS Level II codes for the service/product on both the line for Blood/Blood product and the Processing/Storage.
   • Outpatient Facilities must also bill with modifier “BL” on both the line for Blood/Blood product and the Processing/Storage.
   • Charges for the Blood Administration can be billed on a separate line with Revenue Code 0391 for each date of service. Blood Administration is considered included in reimbursement for Room and Board per Reimbursement Policy Fac 103.
3. Routine Supplies - These supplies are not separately reimbursed and are considered included in the facility charge. Examples include but are not limited to Tubing (IV, Blood, etc.).
4. Unused Blood - When blood or blood products which the Facility has collected in its own blood bank or received from a community blood bank are not used, processing and storage costs incurred by the community blood bank and the Facility cannot be charged to the member.
   • However, certain member-specific blood preparation costs incurred by the Facility (e.g., blood typing and cross-matching; splitting or irradiation) can be charged to the member under Revenue Code Series 30X or 31X (Laboratory and Laboratory Pathological). Member-specific preparation charges should be billed on the dates the services were provided.
   • Where blood or blood product is split or irradiated specifically with the intent of transfusion to a member but is not then used, the outpatient hospital may bill for the services of splitting or irradiating the unit of blood but may not bill for the HCPCS code for the blood product that was not transfused. The date of service must be the date on which the decision not to use the blood was made and indicated in the member’s medical record (Outpatient only).
5. Autologous Blood (Outpatient Only) - In general, when autologous (pre-deposited or obtained through intra- or postoperative salvage) or directed-donor transfusion is performed, facilities should bill for the transfusion service and the number of units of the appropriate HCPCS code that describes the blood product.
   • Reimbursement for the product is intended to cover the costs associated with providing the autologous or directed donor blood product service (e.g., collection, processing, transportation, and storage).
   • Facilities should bill the transfusion service and the blood product HCPCS code on the date that the transfusion took place and not on the date when the autologous blood was collected.
   • When an autologous blood product is collected but not transfused, facilities should bill CPT 86890 (autologous blood or component, collection, processing, and storage; pre-deposited) or 86891 (autologous blood or component, collection, processing, and storage; intra- or postoperative salvage) and the number of units collected but not transfused. CPT 86890 and 86891 are intended to provide payment for the additional resources needed to provide these services, which are not captured when a blood product HCPCS code is not billed.
   • Because billing 86890 or 86891 is only indicated when autologous blood is collected but not transfused, the facility should bill 86890 or 86891 on the date when the Facility is certain the blood will not be transfused (i.e., date of a procedure or date of member discharge), rather than on the date of the product’s collection or receipt from the supplier.
   • When a directed donor blood product is collected but not transfused to the initial targeted recipient or to any other member, refer to the section titled “Unused Blood.”
6. Split Unit of Blood (Outpatient Only) - HCPCS code P9011 was created to identify situations where one unit of blood or a blood product is split, and some portion of the unit is transfused to one member and the other portions are transfused to other members or to the same member at other times.
   • When a member receives a transfusion of a split unit of blood or blood product, facilities should bill P9011 for the blood product transfused, as well as CPT 86985 (Splitting, blood products) for each splitting procedure performed to prepare the blood product for a specific member.
   • Facilities should bill split units of packed red cells and whole blood using Revenue Code 389 (Other blood) and should not use Revenue Codes 381 (Packed red cells) or 382 (Whole blood). Providers should bill split units of other blood products using the applicable revenue codes for the blood product type, such as 383 (Plasma) or 384 (Platelets), rather than 389.
7. Irradiation of Blood Products (Outpatient Only) - In situations where a member receives a medically reasonable and necessary transfusion of an irradiated blood product:
   • An outpatient facility may bill the specific HCPCS code which describes the irradiated product, if a specific code exists, in addition to the CPT code for the transfusion.
   • If a specific HCPCS code for the irradiated blood product does not exist, then the facility should bill the appropriate HCPCS code for the blood product, along with CPT code 86945 (irradiation of blood product, each unit).
8. Frozen and Thawed Blood and Blood Products (Outpatient Only)
   • In situations where a member receives a transfusion of frozen blood or a blood product which has been frozen and thawed for the member prior to the transfusion, an outpatient facility may bill the specific HCPCS code which describes the frozen and thawed product, if a specific code exists, in addition to the CPT code for the transfusion.
   • If a specific HCPCS code for the frozen and thawed blood or blood product does not exist, then the Facility should bill the appropriate HCPCS code for the blood product, along with CPT codes for freezing and/or thawing services that are not reflected in the blood product HCPCS code.
   • If a blood product has been frozen and/or thawed in preparation for a transfusion, but the member does not receive the transfusion of the blood product, the Facility may bill the member for the CPT code that describes the freezing and/or thawing services specifically provided for the member. Similar to billing for autologous blood collection when blood is not transfused, the Facility should bill the freezing and/or thawing services on the date when the Facility is certain the blood product will not be transfused (e.g., date of a procedure or date of member discharge), rather than on the date of the freezing and/or thawing services.

The following chart of blood and blood products indicates whether outpatient facilities should bill separately for freezing and thawing based on HCPCS codes. If this concept is not applicable, the code has been omitted from this chart (for example: P9043, P9048, P9050).

9. Transfusion Services (Outpatient Only)
   • To report charges for transfusion services, facilities should bill the appropriate CPT code for the specific transfusion service provided under Revenue Code 391 (Blood Administration).
   • Transfusion services codes are billed on a per service basis, and not by the number of units of blood product transfused. For payment, a blood product HCPCS code is required when billing a transfusion service code.
   • Blood Transfusions, with CPT codes 36430, 36440, 36450, and 36455 should be billed as one (1) per session, regardless of the number of units transfused on any given date of service.
10. Pheresis and Apheresis Services (Outpatient Only)
    • Apheresis/pheresis services are billed on a per visit basis and not on a per unit basis.
    • Facilities should report the charge for an Evaluation and Management (E&M) visit only if there is a separately identifiable E&M service performed which extends beyond the evaluation and management portion of a typical apheresis/pheresis service.
    • If the outpatient facility is billing an E&M visit code in addition to the apheresis/pheresis service, it may be appropriate to use the HCPCS modifier 25.

Centers for Medicare & Medicaid Services (CMS), Medicare Benefit Policy Manual, Chapter 4 – Part B Hospitals (Including Inpatient Hospital Part B and OPPS) Section 231

American Red Cross, Learn About Blood: Blood Components

CMS Manual System Change Request 6416

Centers for Medicare & Medicaid Services (CMS), Medicare Benefit Policy Manual, Chapter 17 – Drugs and Biologicals

American Red Cross, Reimbursement for Blood Products and Related Services in 2021

CDC, Blood Safety Basics

American Red Cross, Infectious Disease Testing

Reimbursement of Facility Room and Board